Novel Potential Drug Interactions with Bisoprolol in Hospitalized Acute Coronary Syndrome Patients

Abstract

Objectives: Drug-drug interactions (DDI) pose a real challenge especially in patients with complicated therapeutic regimens such as acute coronary syndrome (ACS) patients. Cardiac patients are more vulnerable to potential drug-drug interactions (pDDI). This study aimed to assess DDIs involving Bisoprolol among other drugs in ACS patients. Methods: This is an observational study including 128 hospitalized patients with ACS who were candidates for Bisoprolol therapy and received at least two medications. Bisoprolol peak concentration, heart rate and blood pressure of patients were assessed. Medications of patients were analyzed for potential drug interactions using Micromedex, Lexi Interact and Drugs.com databases. Assessment of actual drug interactions was also conducted.Results: A total of 1039 pDDIs were detected and their severity was categorized into moderate (54.95%) and major (45.04%). Regarding the actual DDIs, 4 drug interactions involving Bisoprolol were identified: Amlodipine/Bisoprolol (2.3%), Empagliflozin/Bisoprolol (10.2%), Aspirin/Bisoprolol (96.9%) and Potassium Chloride/Bisoprolol (10.2%), while 6 drug interactions involving other drugs were observed including Empagliflozin/Spironolactone (7%), Levofloxacin/Insulin (4.7%), Furosemide/Insulin (3.9%), Clopidogrel/Fondaparinux (11.7%), Aspirin/Fondaparinux (13.3%) and Aspirin/Furosemide (8.59%). Conclusions: This study highlighted novel drug interactions such as Amlodipine/Bisoprolol, Empagliflozin/Bisoprolol and Empagliflozin/Spironolactone interactions. The study also emphasized the possible beneficial role of these interactions in ACS patients, this warrants the need for intense monitoring of drug interactions in ACS patients for drug therapy optimization and avoidance of adverse drug reactions.